Forms & Documents
This section of our website is dedicated to supporting Health Plan of San Joaquin providers with valuable tools and resources. Please click here if you are looking for Provider Policies documents.
Forms
Prior Authorization
Provider Manual
If you want to download the full Provider Manual or just individual sections, please click here.
EDI Companion Guides
Emdeon EFT-ERA Enroll Online
Pediatric Obesity Toolkit
| Size: 350 KB Dec 12th, 2018 Me & My Baby Program | Size: 546 KB Oct 26th, 2018 DRE Confidentiality Statement Form | Size: 272 KB Oct 25th, 2018 Synagis Recommendations 2018-2019 | Size: 277 KB Oct 25th, 2018 Synagis Authorization Form 18-19 | Size: 276 KB Apr 26th, 2018 Offset Request Form | Size: 608 KB Apr 17th, 2018 Provider Dispute Resolution Request Form | Size: 137 KB Feb 2nd, 2018 Outpatient Palliative Care Referral Form | Size: 171 KB Jan 24th, 2018 Primary Care Physician / Main Doctor Change Form / English - Spanish | Size: 295 KB Nov 8th, 2017 Member Appeal Form | Size: 221 KB Nov 2nd, 2017 Medication Prior Authorization Form | Size: 340 KB Nov 2nd, 2017 Disease/Case Management Referral Form | Size: 163 KB Jun 19th, 2017 SB137 Provider Data Validation Form | Size: 133 KB Jun 19th, 2017 SB137 Facilities Data Validation Form | Size: 19 KB Jun 21st, 2016 Diabetes Outpatient Education Referral Form - Doctors Medical Center only | Size: 340 KB Jun 20th, 2016 CHEER Program Referral Form | Size: 237 KB Oct 29th, 2015 UM Appeal Cover Sheet | Size: 505 KB Oct 20th, 2015 Specialist Referral Form | Size: 44 KB Jul 17th, 2015 Western Drug DME Order Form
Prior Authorization
Provider Manual
If you want to download the full Provider Manual or just individual sections, please click here.
Provider Portal
HPSJ’s New Electronic Medical Management System – (the Enhanced DRE provider Portal)
EDI Companion Guides
| Size: 341 KB Oct 1st, 2015 270/271 Electronic Eligibility Verification Companion Guide | Size: 370 KB Oct 1st, 2015 276/277 Electronic Claims Status Companion Guide | Size: 208 KB Sep 20th, 2016 CORE Channel Enrollment Form | Size: 989 KB Oct 30th, 2015 Emdeon EFT Enrollment Form | Size: 196 KB Oct 30th, 2015 Emdeon ERA Enrollment Form (non-CORE)
Emdeon EFT-ERA Enroll Online
Pediatric Obesity Toolkit
PlanScan Provider Newsletter
Preventive Health Guidelines
| Size: 4 MB Jun 19th, 2018 PlanScan Fall 2017 | Size: 4 MB May 23rd, 2018 PlanScan Summer 2018 | Size: 1 MB Jan 19th, 2018 PlanScan Winter 2018 | Size: 2 MB Jul 18th, 2017 PlanScan Spring/Summer 2017 | Size: 3 MB Feb 28th, 2017 PlanScan Winter 2017 | Size: 5 MB Jan 13th, 2017 PlanScan Fall 2016 | Size: 7 MB Apr 29th, 2016 PlanScan Spring 2016 | Size: 2 MB Apr 29th, 2016 PlanScan Winter 2015 | Size: 3 MB Apr 29th, 2016 PlanScan Fall 2015 | Size: 4 MB Apr 29th, 2016 PlanScan Spring/Summer 2015 | Size: 3 MB Apr 29th, 2016 PlanScan Spring/Summer 2014
Behavioral Health Care Services
Beacon PCP Toolkit
Beacon PCP Toolkit
Pharmacy Tools & Resources
| Size: 221 KB Nov 2nd, 2017 Medication Prior Authorization Form | Size: 425 KB Oct 30th, 2017 Generic Drug Price Review Request Form | Size: 143 KB Oct 27th, 2015 HPSJ Formulary Prescriber Guide | Size: 1,022 KB Sep 25th, 2015 HPSJ’s Cognitive Services Program | Size: 548 KB Aug 25th, 2015 Pharmacy Cognitive Services Compensation Program | Size: 529 KB Aug 25th, 2015 Emergency Supply Override Policy | Size: 377 KB Aug 13th, 2015 Emergency Medication Supply Form | Size: 90 KB Jul 17th, 2015 Formulary Addition Request
Posted on June 17th, 2015 and last modified on December 12th, 2018.